Evaluation Of The Study “Muscle Endurance Deficits In Myositis Patients Despite Normal Manual Muscle Testing Scores”
The article discussed is entitled “Muscle endurance deficits in myositis patients despite normal manual muscle testing scores”, by Amici et al (2018), which was published in Muscle & Nerve. Amici et al (2018) evaluate whether quantifying muscle endurance provides nonredundant and useful information to patients affected by muscular disease. The inflammation of the muscles used to move the body greatly weakens one’s muscles. This typically results in noticeable functional loss, such as respiratory abnormality in function, lack of ability to ambulate, inability to perform ADLs and can impact other features such as how one eats, breathes, speaks, and manages their fine motor control. It can be argued all these features are a result of muscle strength and is evidence of the need to have direct strength measurements as the basis of experimental therapies for motor neuron disease.
Amici et al (2018) primarily are concerned the quantifying of muscle endurance does not provide additive information. For this study, the authors reviewed the records of 128 Johns Hopkins Myositis Center patients with a recorded muscle endurance assessment. They performed 226 patient visits. Amici et al (2018) quantified muscle endurance with the Myositis Functional index-2 (Fl2) and strength with manual muscle testing (MMT). Muscle endurance testing can prove useful. Patients with high MMT scores often had inadequate identification of muscle impairment. With patients with a normal or near-normal strength (meaning MMT > 9. 75/10), muscle endurance was highly variable (interquartile range 3. 3-7. 8/10) or typically abnormally (mean Fl2 5. 6/10). The Fl2 scores were comparable to the body myositis (n=58), polymyositis (n=39), and dermatomyositis (n=31). Two client factors impacted are muscle power and muscle endurance. The researches wanted to verify whether Fl2 could be useful in providing a more complete picture of a patient’s muscles in terms of strength and endurance. Their therapy will need to target this arena to slow down the rate of progression in their disease, which should be based on accurate and relevant data. The skill most impacted seemed to be “grips, ” meaning the ability of the individual to pinch or grasp an object to prevent it from slipping or falling. The tested participants have myositis, though the results of the study did not specify any differentiation between those with body myositis, polymyositis, or dermatomyositis. One’s muscles directly impact the ability to perform an ADL, a skill necessary for activities of daily living.
This study helps to understand the data points needed to provide an effective therapy. Based on this reading, there is notable concern regarding high MMT being unable to identify muscle impairment. This may mean the individuals need additional therapy sessions targeting muscle weakness or further evaluation. This could also mean a risk to the patient for further damage if the occupational therapist is unaware there is muscle impairment.
The results of this study still leave significant questions as to how the type of myositis might impact the data points, such as whether the skew favors certain muscle groups.
